Meperidine

The Basics

What is Meperidine?

Used to help relieve moderate to severe pain and may also be used before and during surgery or other procedures.

Brand names for Meperidine

Demerol

How Meperidine is classified

Analgesics – Opioid, Narcotics, Opiates

Meperidine During Pregnancy

Meperidine pregnancy category

Category Not AssignedNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Meperidine while pregnant

Prolonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome . Available data with DEMEROL Tablets or Oral Solution are insufficient to inform a drug-associated risk for major birth defects and miscarriage. Formal animal reproduction studies have not been conducted with meperidine. Neural tube defects (exencephaly and cranioschisis) have been reported in hamsters administered a single bolus dose of meperidine during a critical period of organogenesis at 0.85 and 1.5 times the total human daily dose of 1200 mg . Adverse outcomes in pregnancy can occur regardless of the health of the mother or the use of medications. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. Clinical Considerations Fetal/Neonatal Adverse Reactions Prolonged use of opioid analgesics during pregnancy for medical or nonmedical purposes can result in physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth. Neonatal opioid withdrawal syndrome presents as irritability, hyperactivity and abnormal sleep pattern, high pitched cry, tremor, vomiting, diarrhea, and failure to gain weight. The onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on the specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination of the drug by the newborn. Observe newborns for symptoms of neonatal opioid withdrawal syndrome and manage accordingly .

Taking Meperidine While Breastfeeding

What are recommendations for lactation if you're taking Meperidine?

Other agents are preferred over meperidine during breastfeeding.[1][2] Intravenous meperidine during labor can interfere with nursing and maternal use of meperidine during breastfeeding can sedate the infants. Patient-controlled epidural analgesia postpartum appears to be free from these effects. However, other agents, such as fentanyl, are preferred for intravenous or intramuscular use, especially while nursing a newborn or preterm infant.[3] Labor pain medication may delay the onset of lactation. A single dose for anesthesia or conscious sedation usually does not cause problems in older breastfed infants.[4][5] When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother’s milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of meperidine to a few days at a low dosage with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.

Maternal / infant drug levels

Other agents are preferred over meperidine during breastfeeding.[1][2] Intravenous meperidine during labor can interfere with nursing and maternal use of meperidine during breastfeeding can sedate the infants. Patient-controlled epidural analgesia postpartum appears to be free from these effects. However, other agents, such as fentanyl, are preferred for intravenous or intramuscular use, especially while nursing a newborn or preterm infant.[3] Labor pain medication may delay the onset of lactation. A single dose for anesthesia or conscious sedation usually does not cause problems in older breastfed infants.[4][5] When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother’s milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of meperidine to a few days at a low dosage with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.

Possible effects of Meperidine on milk supply

Meperidine can increase serum prolactin.[14] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed. More importantly, meperidine is likely to interfere with infant nursing behavior when given during labor.[15][16][17]

In one small study, women given promethazine with meperidine and secobarbital during labor, had the time to lactogenesis II prolonged by 14 hours. Women given meperidine or secobarbital without promethazine had lactogenesis II prolonged 7 hours compared to unmedicated women, but the difference was not statistically significant.[18]

A randomized, multicenter trial compared the initiation rate and duration of breastfeeding in women who received high-dose epidural bupivacaine alone, or one of two low-dose combinations of bupivacaine plus fentanyl. A nonepidural matched control group, some of whom received systemic meperidine, was also compared. Women in the nonepidural group who received systemic meperidine had a lower breastfeeding initiation rate than in the epidural or unmedicated groups.[19]

A national survey of women and their infants from late pregnancy through 12 months postpartum compared the time of lactogenesis II in mothers who did and did not receive pain medication during labor. Categories of medication were spinal or epidural only, spinal or epidural plus another medication, and other pain medication only. Women who received medications from any of the categories had about twice the risk of having delayed lactogenesis II (>72 hours) compared to women who received no labor pain medication.[20]

A randomized, nonblinded study compared the use of intramuscular meperidine 100 mg to intranasal (mean dose 486 mcg) or subcutaneous (mean dose 300 mcg) fentanyl for labor analgesia. More women in the meperidine group had difficulty establishing lactation (79%) than in the intranasal (39%) or subcutaneous (44%) fentanyl groups. Mothers who received meperidine reported more sedation, had longer labors, and their infants were more likely to be admitted to the nursery.[21][22]

Analysis of an Australian database of 1835 pregnant women found that the 285 women who received meperidine during labor were 41% more likely to have discontinued breastfeeding by 6 weeks of age.[23]

A study of lactose, protein, sodium and potassium concentrations in the breastmilk found slightly higher lactose concentrations in the milk of mothers who delivered vaginally and received no meperidine compared to those who had a Cesarean section followed by patient-controlled analgesia with meperidine in the first 72 hours postpartum. Between 72 and 165 hours postpartum, vaginally delivered mothers without meperidine had lower sodium and protein content and higher potassium content in milk than those who received meperidine. However, by 72 hours postpartum, both groups had evidence of adequate secretory activation.[24]

A retrospective case-control study conducted in two hospitals in central Iran compared breastfeeding behaviors in the first 2 hours postdelivery by infants of 4 groups of primiparous women with healthy, full-term singleton births who had vaginal deliveries. The groups were those who received no medications during labor, those who received oxytocin plus scopolamine, those who received oxytocin plus meperidine, and those who received oxytocin, scopolamine and meperidine. The infants in the no medication group performed better than those in all other groups, and the oxytocin plus scopolamine group performed better than the groups that had received meperidine.[25]

Use of a combination of meperidine 50 mg and levallorphan 0.625 mg (Pethilorphan) per dose intramuscularly as a last resort for severe labor pain was studied retrospectively in a hospital in Japan that did not use epidural analgesia. It was often used with hydroxyzine 50 mg or promethazine 25 mg intramuscularly. Outcomes were compared to those of women who received no meperidine. Although women who received meperidine plus levallorphan had several indications of more difficult labor and delivery, there was no difference in the rates of suckling difficulties or breastfeeding rates at discharge or 1 month postpartum between the groups. No differences between dosages of meperidine received was found.[26]

A randomized, partially blinded study in a hospital in Thailand compared intravenous meperidine and fentanyl for pain during active labor. Mothers received either meperidine 50 mg (n = 46) or fentanyl 50 mcg (n = 46) initially and then every 1 (fentanyl) or 2 (meperidine) hours as requested by the mother. The percentages of infants who breastfed in the first 24 hours were only 61% for meperidine and 54% for fentanyl, although the difference was not statistically significant. Care of the infants (e.g., skin-to-skin in the first hour) was not reported.[27]

Possible alternatives to Meperidine

Acetaminophen, Butorphanol, Fentanyl, Hydromorphone, Morphine.